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How does plaque psoriasis cause pain?

Psoriasis is a chronic autoimmune condition in which inflammation causes symptoms to appear on the skin—including plaques. Plaques are patches of skin that are thickened, inflamed, red, and scaly. Living with psoriasis can cause a great amount of discomfort and pain, especially during flare-ups1.

Plaques can cause frequent, intense itching and burning sensations, and can be particularly uncomfortable when they are located in areas such as the scalp or groin. If psoriasis plaques affect the palms of the hands and the soles of the feet, it can make walking and carrying-out daily activities very difficult due to the pain they cause. Because the skin in areas affected by plaques can be very dry, plaques can develop painful cracks and bleeding2. This is particularly common in plaques located on the elbows, knees, and other joints that are constantly moving and flexing.

For some people, the pain caused by psoriasis can significantly affect quality of life. It can make activities like working, sleeping, and self-care very difficult and uncomfortable. However, some people with psoriasis do not experience much pain and can continue carrying out their normal activities3.

How does psoriasis cause pain?

One source of pain caused by psoriasis is the tissue damage the condition causes, such as cracks (also known as fissures). Nerve endings in the skin can be activated in damaged tissue and trigger pain signals in the brain. The inflammation caused by psoriasis is thought to affect the way that the brain processes pain signals. Researchers are working to learn more about the link between psoriasis and pain, and why some patients experience more pain than other patients with a similar level of disease severity4.

Research has also shown that the experience of pain can be influenced by many factors. For example, patients in warm and sunny climates tend to report less pain. The experience of pain is also affected by issues such as5:

Scientists used to believe that patients with psoriasis could not have the symptoms of itching and pain at the same time because their signals travel along different pathways through the spinal cord to the brain. Thanks to a new area of research focusing on itching and ways to treat it, researchers now understand that there are many connections between the two feelings and that they can occur at the same time.

How common is pain among people with plaque psoriasis?

Skin pain is common among people with psoriasis, reported by up to 42% of psoriasis patients. Pain seems to be more common among4:

Women

Patients who are older

Patients with more severe psoriasis

Patients who have had psoriasis longer

Patients who have other health conditions related to psoriasis

How is psoriasis pain treated? 1,6

People who are experiencing pain due to psoriasis may find that over-the-counter or prescription pain relievers, such as nonsteroidal anti-inflammatory drugs (aspirin and ibuprofen, for example) are effective in reducing inflammation and therefore pain. Others find Tylenol (acetaminophen) helpful for pain relief, although it does not reduce inflammation1.

However, those pain relievers do not affect the plaques that are a main source of the pain. Treating the chronic inflammation caused by psoriasis is the only way to reduce the plaques and other symptoms. Treatments for psoriasis depend on the severity of the disease. For mild psoriasis, topical treatments applied directly to the affected skin can be effective in reducing symptoms. For psoriasis that is more severe, treatment with stronger medications that affect the entire body may be needed.

Systemic medicines, such as methotrexate and biologic therapies, such as etanercept, that work by suppressing the immune system to reduce inflammation

Because pain can be made worse by stress or other negative feelings, some patients find techniques like meditation, relaxation, and deep-breathing techniques, and acupuncture to be helpful in controlling pain.

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